HA | PAD vs PVD Only

This episode covers everything PAD vs PVD and highlighting the differences and similarities.

🔎 Big Picture (Pareto)

• PAD = arterial inflow failure ➜ ischemia.
• PVD (venous) = return failure ➜ pooling/edema.
• Position test: PAD pain ↓ with dangling ⬇️🦵; PVD pain/edema ↓ with elevation ⬆️🦵.
• Skin/ulcers: PAD = pale, cool, shiny, hairless; distal, dry “punched-out” ulcers (toes). PVD = warm, brown (hemosiderin), thick; medial ankle, wet/irregular ulcers.
• Pulses: PAD weak/absent 🚫; PVD usually present ✅.

🩸 PAD (Peripheral Artery Disease)

Patho: Progressive arterial narrowing → ↓ perfusion → claudication → rest pain → CLI. Hallmarks: Intermittent claudication (exertional ischemic pain, resolves ≤10 min with rest), paresthesia, shiny/taut skin, hair loss, elevation pallor & dependent rubor, rest pain worse at night/elevation. CLI red flags: >2 wks rest pain, nonhealing arterial ulcers, gangrene (↑ risk w/ DM, HF, prior stroke).

Dx 🧪:

• ABI = ankle SBP / higher brachial SBP (⚠️ may be falsely high in DM/elderly due to calcification).
• Doppler/duplex, segmental pressures, (MR)angiography.

Procedures: PTA ± stent; surgical bypass (autogenous vein preferred); prostanoids (CLI, not FDA-approved for CLI); conservative CLI care (pain control, infection prevention, protect limb).

Nursing priorities 🩺:

• Post-revasc: Hourly distal pulses, color/temp/cap refill; REPORT new pain, pallor/cyanosis, numbness/tingling, pulse loss ➜ possible acute occlusion.
• Positioning: Avoid knee flexion, early ambulation, no prolonged sitting.
• Education: Smoking cessation, daily foot checks, protective shoes (round toe, soft insole), avoid trauma.
• Symptom relief: Dangle legs for rest pain (gravity aids flow).

♻️ CVI & Venous Leg Ulcers (chronic venous PVD)

Patho: Venous hypertension → fluid/RBC leak → edema, inflammation, brown (hemosiderin) discoloration, thick/leathery skin; eczema; painful dependent legs; high infection risk.

Cornerstones of care 🧵:

• Compression = primary (stockings/bandages/IPC/wraps) ONLY after ruling out PAD (ABI first).
• Elevate legs above heart, daily walking; avoid prolonged sitting/standing & trauma.
• Moist wound care, monitor for infection; nutrition: protein + vitamins A/C + zinc; tight glucose control in DM.

🚨 Rapid Compare (teach-back)

• Pain: PAD ⛔ elevation, ✅ dangling; PVD ✅ elevation.
• Pulses/Temp: PAD ↓/cool; PVD normal/warm.
• Color/Skin: PAD pale→rubor, shiny/hairless; PVD brown, thick, edematous.
• Ulcers: PAD toe/distal, dry & round; PVD medial ankle, wet & irregular.
• First moves: PAD ➜ assess pulses, dangle, no compression; PVD ➜ elevate + compress (if no PAD). ✅